In an attempt to induce discussions between patients and providers, North Carolina's largest health insurer—Blue Cross and Blue Shield of North Carolina (BCBSNC)—in late January started posting statewide averages costs for...
In an attempt to induce discussions between patients and providers, North Carolina’s largest health insurer—Blue Cross and Blue Shield of North Carolina (BCBSNC)— in late January started posting statewide averages costs for hundreds of procedures, prescription drugs, office visits, and dozens of other outpatient and hospital services on its website. Named the Health Care Cost Estimator, the service is part of a password-protected suite of services that includes the ability to check claims and benefits, Mark Stinneford, BCBSBC spokesperson, told MDNG.
Health insurance members have been sheltered from healthcare costs for a long time, explains Stinneford, adding that it’s important for them to now become more aware of these costs. “First, it gives them an idea of where their premium dollar goes, because the prices we pay translate into the premiums they pay. Secondly, members are paying for an increasing share of healthcare costs, and until now they haven’t had a source of realistic information to help them determine what services actually cost. Without this information, consumers can often mistakenly think that a drug or doctor’s office visit can cost $20 or $30, or whatever they have to pay out of pocket, when the cost is usually several times that. Finally, what we pay and what they pay out of pocket can vary dramatically for the same service, depending on where they go for the service. For instance, for an outpatient MRI or a colonoscopy, it can vary widely depending on whether you get it in a hospital outpatient setting or a doctor’s office. It’s in members’ interest—as they try to get information both about quality of care and cost-effective care—to know about the distinctions in cost based on the place where the service is performed. This is another way that helps them determine that.”
The importance of the service goes beyond its usefulness for members; it represents the push among the industry for consumers to play a larger role in holding down healthcare costs. “Coverage is headed toward offering employees a variety of high-deductible plans,” said John McDonnell, a partner in Progressive Benefit Solutions of Raleigh. “To make good decisions about those plans, consumers need good information about the costs of healthcare. This is a step in that direction.” The idea behind high-deductible plans is the annual premiums can be held down by requiring patients to meet much-higher-than-traditional deductibles, estimated to be $2,000 to $10,000 per year. Knowing how much to set aside, via services such as BCBSNC’s Health Care Cost Estimator, is key to helping patients live in the future world of high-deductible plans.
However, the Health Care Cost Estimator may have unintended consequences. “It’s possible that people might look at the costs and simply delay care,” said Steve Graybill, senior benefits consultant, Mercer Human Resource Consulting, Charlotte, NC. “For emergency services, our role is to make sure our members have access to quality care; when members have a healthcare crisis, we want to make sure they have access to quality care and that their claims are paid without hassle,” Stinneford responds. “In that situation, it’s not really realistic to expect the consumer to be worried about cost or check costs. But there are a number of things that one knows are coming up during a year that aren’t a crisis, and for which you can check the price. For example, if you hit a certain age, the doctor is going to recommend a colonoscopy. That’s not something you need to get tomorrow, so you have the opportunity to check the cost. If you know you’re going for an annual physical, and you do that around the same time every year, you have the chance to check the price for that. If you know that your child goes to the pediatrician, say, four to six times a year for a cold or flu visit, you can determine in advance how much you’re likely to pay and how much we’re likely to pay. It’s particularly helpful as consumers pay a greater proportion of costs and the market shifts to things like health savings accounts. It allows members to plan for expenses they know are going to happen. Again, when you have a health crisis, that’s not the thing you’re going to be thinking about, nor do we want you to be thinking about that.”
The availability of cost and pricing information also opens the doors for patient—physician communication, in order to find the best option for a patient. “...I may also say, ‘This is really bothering me,’ and go back to my physician and ask if there are other alternatives at a lower cost,” said Graybill. “It gets that conversation going.”
As the largest insurer in North Carolina, BCBSNC hopes that leading by example will cause other insurers to follow. “We see as part of our mission to improve the health of all North Carolinians, and part of that is having better information,” said Don Bradley, chief medical officer, BCBSNC.
What the Health Care Cost Estimator doesn’t do is provide charges levied by specific doctors, which would allow patients to doctor shop. Although patients need better and more information if they’re to be held responsible for holding down healthcare costs, the insurance companies certainly aren’t unaware that competitors could easily find out specific reimbursement rates they negotiate with providers. Plus, some contracts prevent doing so. And this conflict is at the center of the problems pointed to by critics of high-deductible insurance. "I really think it's about trying to deflect blame and say it's all the patient's responsibility," said Adam Searing, project director, N.C. Justice Center's Health Access Coalition, Raleigh. "Sure, consumers have some responsibility, but you don't want to be sitting there with a calculator and some website trying to decide if you can afford an MRI. What kind of health-care system is that?"
Read BCBSNC’s press release announcing the availability of the Health Care Cost Estimator.